Managing the needs of female patients

By Nancy Groves

AMD: Women’s greatest visual threat

Women’s greatest visual threat is age-related macular degeneration (AMD), says Pamela A. Lowe, OD, FAAO, in private practice in Niles, IL. She says that the prevalence of AMD exceeds that of glaucoma and diabetic retinopathy combined among Americans (male and female).

“Especially with women being two to one over our male patients, I think it’s very important to give them every opportunity to treat AMD early,” she says.       

However, early AMD is not adequately detected by current methods, and up to 78 percent of AMD patients have irreversible vision loss at their first diagnosis, she says.         

This level of unnecessary vision loss may be lessened by use of AREDS2 nutritional supplements in certain patients who have not progressed to advanced AMD as well as by behavioral modifications, Dr. Lowe says. But in her practice, Dr. Lowe has added evaluation of dark adaptation to her management strategies.          

The earliest changes in the sequence of events that could ultimately lead to vision loss happen at the microscopic level and can’t be seen with current technology until they become drusen. This early degeneration has several effects, including a localized deficiency of vitamin A that can be measured with dark adaptation, Dr. Lowe says.

“Impaired dark adaptation isn’t a risk factor for AMD,” she says. “It’s the earliest manifestation of the disease.”

For the past two years, Dr. Lowe has been using a dark adaptometer (AdaptDx, Maculogix) to screen patients. The instrument has two clinical protocols: a rapid test for quick assessment (≤6.5 minutes) and an extended test for benchmarking (≤20 minutes). If the retina can adapt in less than 6.5 minutes, then vision is normal and there is no localized vitamin A deficiency. In patients who have AMD, whether early, moderate, or advanced, adaptation will take longer. While the rapid test yields information quickly, Dr. Lowe generally runs the extended test, which can tell her not only if a patient has AMD but to what extent.          

When a patient has a positive result, the next step is to look at the other characteristics of the retina with imaging tools, Dr. Lowe says. If drusen, pigmentary changes, and evidence of choroidal neovascularization are found, she follows the American Optometric Association’s AMD patient treatment protocol, adding dark adaptation to the list of tests. If there are no other characteristics of AMD, she follows the protocol for subclinical AMD patients, again adding dark adaption testing as well as counseling on diet, nutritional supplementation, exercise, UVA and UVB protection, and smoking cessation to the management options.

She also uses genetic testing, especially with subclinical patients.

“I want to know how to target my high-risk patients,” she says. “I want to help them before they lose any vision and have to go to a retina specialist.”

Dr. Lowe recommends the Macula Risk PGx test (Arctic Dx), which evaluates a patient’s current AMD status, genetic predisposition, and nongenetic risk factors to determine the two, five, and 10-year risk of progression.……

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Source: Optometry Times